Korean Journal of Clinical Pharmacy (한국임상약학회지)

Korean College Of Clinical Pharmacy (한국임상약학회)
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Validation of Voriconazole Therapeutic Drug Monitoring in Lung Transplant Recipients Receiving Voriconazole alone for Treatment of Invasive Aspergillosis

침습성 아스페르길루스증의 치료 목적으로 voriconazole을 단독으로 투여받는 폐이식 환자에서 voriconazole 약물혈중농도 모니터링의 유효성 검증

  • Son, Yu Jeong (Department of Pharmacy, Severance Hospital, Yonsei University College of Medicine) ;
  • Lee, Kyung A (Department of Pharmacy, Severance Hospital, Yonsei University College of Medicine) ;
  • Jo, Ju Hee (Department of Pharmacy, Severance Hospital, Yonsei University College of Medicine) ;
  • Kim, Jae Song (Department of Pharmacy, Severance Hospital, Yonsei University College of Medicine) ;
  • Son, Eun Sun (Department of Pharmacy, Severance Hospital, Yonsei University College of Medicine) ;
  • Park, Moo Suk (Department of Internal Medicine, Yonsei University College of Medicine)
  • 손유정 (연세대학교 의과대학 세브란스병원 약무국) ;
  • 이경아 (연세대학교 의과대학 세브란스병원 약무국) ;
  • 조주희 (연세대학교 의과대학 세브란스병원 약무국) ;
  • 김재송 (연세대학교 의과대학 세브란스병원 약무국) ;
  • 손은선 (연세대학교 의과대학 세브란스병원 약무국) ;
  • 박무석 (연세대학교 의과대학 내과학교실)
  • Received : 2019.02.22
  • Accepted : 2019.05.07
  • Published : 2019.06.30
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Abstract

Background: Invasive aspergillosis (IA) is associated with high morbidity and mortality, particularly among immunocompromised patients, such as lung transplant recipients. Voriconazole, the first-line therapy for IA, shows a non-linear pharmacokinetic profile and has a narrow therapeutic range. Careful and appropriate administration is necessary, primarily because it is used for critically ill patients; however, the clinical usefulness of therapeutic drug monitoring (TDM) has not been sufficiently verified. Therefore, in this study, we validated the safety and efficacy of voriconazole TDM in lung transplant recipients receiving only voriconazole for IA treatment. Methods: The electronic medical records of lung transplant recipients (${\geq}19$ years of age) administered only voriconazole for > 7 days for treatment of IA from June 1, 2013 to May 31, 2018 were analyzed retrospectively. Results: Among the 54 patients, 27 each were allocated to TDM and non-TDM groups, respectively. There were no significant differences in patient characteristics between the two groups except for ICU-hospitalization status. Of the TDM group patients, 81.5% needed adjustment of voriconazole dosage because the levels were out of target range. Comparison of two groups showed that treatment response was higher throughout treatment and switching rates of second-line agents were significantly lower in the TDM group, but it was insufficient to confirm safety improvements through voriconazole TDM. Conclusions: Considering that the treatment response tended to be higher and the rates of switching to second-line antifungal agents were lower in the TDM group, voriconazole TDM may increase the therapeutic effect on IA in lung transplant patients.

Keywords

References

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